Blood Culture

Blood culture to detect bacteremia is an important investigation with major implications for the
diagnosis of patients with infection and the selection of appropriate treatment. Microorganisms
are present on the skin surface of patients, staff and the immediate patient environment which
can result in the contamination of blood cultures. Contamination can cause confusion because it
is sometimes difficult to determine if a positive blood culture is due to genuine bacteremia or if
it is a 'false positive' result caused by contamination. Contaminated blood cultures can therefore
lead to patients receiving inappropriate treatment which they do not need and which can be
potentially harmful.
Coagulase negative staphylococci are the commonest blood culture skin contaminant.
There are many signs and symptoms in a patient which may suggest bacteremia and clinical
judgment is required, but the following indicators should be taken into account when assessing
a patient for signs of bacteremia or sepsis:
Core temperature out of normal range;
Focal signs of infection;
Abnormal heart rate (raised), blood pressure (low or raised) or respiratory rate (raised);
Chills or rigors;
Raised or very low white blood cell count; and
New or worsening confusion.
Blood cultures should be taken after identification of possible bacteremia or sepsis and before
the administration of antibiotics. If a patient is on antibiotics, blood cultures should ideally be
taken immediately before the next dose, with the exception of pediatric patients.
Only take blood for culture when there is a clinical need to do so and not as
routine.
Blood cultures are ordered as a set, which consist of 2 bottles (1 Aerobic bottle and
1 Anaerobic bottle).

The Blood Culture bottles!

At Ruwais hospital (BD BACTEC) culture bottles is in use.
With 3 types differentiated by the media they contains :
1. BD BACTEC Plus Aerobic/F.
Contains resins for antibiotic neutralization. Recommended for use in adult
populations due to higher blood volume capacity and resins. Recommended for 3.0
to 10.0 mL (8.0 to 10.0 mL optimal) blood volume.

2. BD BACTEC Plus Anaerobic/F.

Contains resins for antibiotic neutralization. Recommended for use in adult
populations due to higher blood volume capacity and resins. Recommended for 3.0
to 10.0 mL (8.0 to 10.0 mL optimal) blood volume.
3. BD BACTEC Peds PLUS/F.
Contains resins for antibiotic neutralization. Optimized to detect organisms associated
with pediatric septicemia and for low blood volumes (1.0 3.0 mL optimal; 0.5 to
5.0 mL recommended).
Meeting your curiosity here some information to know about how they work;
When microorganisms are present in culture vials, they metabolize nutrients in the culture
medium, releasing carbon dioxide into the medium. A dye in the sensor at the bottom of the vial
reacts with CO2. A photo detector at each station (in Laboratory) measures the level of
fluorescence, which corresponds to the amount of CO2 released by organisms. Then the
measurement is interpreted by the system according to pre-programmed positivity parameters.
A test cycle of all rows is completed every ten minutes by the machine (in laboratory). Positive
cultures are immediately flagged by an indicator light on the front of the instrument, an audible
alarm, and are displayed on the LCD display.
When positive vials are identified, the lab technologist pulls them from the instrument for
confirmation of results, and for isolation and identification of the organism.

The Contaminated Blood Culture

IF the skin is not adequately cleansed before drawing blood for culture, bacteria on the skin will
be injected into the bottle, producing a false positive blood culture.

Principles of Blood Culture

1.
2.
3.
4.

A physicians order must be obtained for specimen collection.

Appropriate verification of the patients identity, As per Ruwais hospital Policy.
Cultures should be drawn before administration of antibiotics, if possible.
If at all possible, blood cultures should not be drawn from lines, but should be drawn via
venipuncture.
5. Aseptic technique is essential to avoid contamination the specimen with organisms
colonizing the skin or the collectors hand.
6. The diaphragm tops of the cultures bottles are not sterile and must be cleaned with
alcohol before injecting blood into the culture bottles.
7. Only use a femoral venipuncture site as a last resort due to skin contamination by fecal
bacterial flora in the area. Scrupulous skin antisepsis must be done if a femoral site is
used.

Preparation
1. Patient Identification as per Ruwais Hospital Policy.
2. Consent Form is signed (general consent).
3. The patient shall receive an explanation and information prior to do the procedure and
education.
4. Maintain Patients Privacy and modesty at all times.
5. Place patient in comfort position, keeping in consideration procedure is doable in that
position
6. Check the Order of the physician regarding the specimen or sample that needs to be
collected.
7. Ensure the correct container for the specimen and clearly labeled with name of the
patient, file number, date and time specimen was collected and site or location.
8. Equipment/Materials needed preparation:
a. Chlorhexidine swabs or Povidone-iodine swabs.
b. Alcohol swabs.
c. Blood culture bottles (2 bottles per set Aerobic and Anaerobic).
d. 2 Syringes (Adult 20 cc, Pediatric 5cc). OR Butterfly blood collection set and
Vacutainer holder.
e. Needle (Adult 22 gauge or larger, pediatric 25 gauge or 23 gauge).
f.

Gloves Sterile.

g. Gloves Non sterile.

h.

Tourniquet.

i.

Sterile gauze.

j.

Adhesive tape.

k. Hazard bag.

Procedure
STEP 1. SKIN PREPARATION:
1.
2.
3.
4.

Hand washing.
Apply gloves and Apply tourniquet and select puncture sites.
Cleanse the venipuncture site with 70% isopropyl alcohol.
Starting at the middle of the site, swab concentrically with chlorhexidine-gluconate or
less recommended with iodine solution.
5. Allow the site to air dry.

STEP 2. PREPARE VIALS:

1. Mark culture vial label(s) at desired fill level.
2. Remove flip-off caps from culture vials(s).
3. Wipe tops of vials with single alcohol swab and allow to dry due to fact the tip of the
bottles is not sterile they are clean only.

STEP 3. BLOOD COLLECTION OPTIONS

Winged Blood Collection Sets with lure (Butterfly Needle) for Vacutainer
connection
1.
2.
3.
4.
5.
6.
7.

Peel apart package and remove blood collection set.

Thread the Luer end of tubing set into Vacutainer holder.
Remove sheath covering needle at wings.
Perform venipuncture by holding wings as shown.
Select aerobic bottle first. Hold the bottle upright.
Push and hold Vacutainer holder over top of vial to puncture septum.
Collect blood to desired fill level on vial. Monitor to ensure proper blood flow and fill
level.
8. Remove holder from vial. Immediately push and hold holder onto second vial.
9. Collect blood to desired fill level on second vial. Remove holder from vial.
10. Gently rotate the bottle between the palm of your hands. Maintaining the upright
position of the bottle.

Needle and Syringe Collection

1.
2.
3.
4.

Using aseptic technique, attach needle to syringe.

A 20 mL syringe with a 21 gauge needle is recommended but other sizes may be used.
Insert the needle into prepared vein and collect 10 to 20 mL blood in syringe.
Withdraw needle after collecting 10-20 mL blood in syringe.
5. Distribute blood equally into aerobic and anaerobic vials.
6. Gently rotate the bottle between the palm of your hands. Maintaining the upright
position of the bottle.
STEP 4. PATIENT SKIN CARE
1. Place the gauze pad over the site, continuing mild pressure. Check bleeding has ceased,
and apply an adhesive or gauze bandage over the site.
2. After all specimens have been collected, remove remaining skin antiseptic from
collection site using a sterile alcohol swab.

STEP 5. LABEL VIALS AND DISPATCHING

1. Label all vials. DO NOT write on or place any labels over the vial barcode, as this is used
by the instrument to process the specimen.
2. Dispatch the vials immediately to the laboratory following Ruwais hospital laboratory
hazard bags and Box.
STEP 6. DISPOSAL
1. Dispose of the blood collection devices in the nearest sharps container according to
regulations.
2. Dispose of all other used materials in appropriate container.
3. wash hands.
STEP 7. Documentation
1. Record the procedure with indication for culture, time, site of venipuncture and any
complications.
2. Notify doctor about the procedure completion so treatment wont be delayed if indicated.

References :
1. BACTEC Plus Aerobic/F and Plus Anaerobic/F Culture Vials Insert. Rev. PP- 088
(2008/01) BD Diagnostics.
2. BACTEC Peds Plus/F Culture Vials Insert.Rev. PP-091(2008/01) . BD Diagnostics.
3. Ashford & St. Peter's Hospitals (2008), Blood Culture Policy.
4. Department of Health (2007), Saving Lives: reducing infection, delivering clean and
safe care.
5. Department of Health: London www.clean-safe-care
6. Gateshead Health NHS Foundation Trust (2008), Blood Culture Policy.
7. Salisbury NHS Foundation Trust (2008), Aseptic Procedure Guidelines